摘要
目的分析探讨急诊失血性休克患者中心静脉导管感染的危险因素及病原学特点。方法回顾性分析上海市第一人民医院2016年6月至2022年6月急诊收治的失血性休克并行中心静脉置管的患者,根据是否发生导管相关性血流感染分为感染组和无感染组,采集感染患者的穿刺部位样本及导管头端样本进行病原学检测和药敏试验。分析两组各项基线资料的差异,并以多因素Logistic回归分析中心静脉导管相关性感染与各项影响因素的关系。结果本研究共纳入患者249例,感染组54例,无感染组195例。感染组年龄、置管位置、失血量、超声引导下穿刺、高急性生理功能和慢性健康情况Ⅱ评分(acute physiology and chronic health evaluationⅡscore,APACHEⅡ评分)、导管留置时间和应用广谱抗生素与无感染组相比较差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,高龄、股静脉置管、未在超声引导下穿刺、APACHEⅡ评分、较长的导管留置时间、应用广谱抗生素为中心静脉导管相关性血流感染的独立危险因素。54例感染患者送检标本检出病原菌中以表皮葡萄球菌最多占44.4%,其次为大肠埃希菌占24.1%,真菌占11.1%;革兰阳性球菌对万古霉素的耐药率最低为3.4%,其次是四环素为34.5%,对阿莫西林的耐药率最高为100.0%;革兰阴性杆菌对阿米卡星以及头孢曲松的耐药率相对较高,均为94.7%。结论急诊失血性休克患者中心静脉导管相关性血流感染的危险因素包括高龄、股静脉置管、未在超声引导下穿刺、较高的APACHEⅡ评分、导管留置时间过长、应用广谱抗生素;常见的病原菌为表皮葡萄球菌和大肠埃希菌。
Objective To analyze the risk factors for central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock.Methods Patients with hemorrhagic shock and central venous catheterization admitted to the emergency department of Shanghai First People's Hospital from June 2016 to June 2022 were retrospectively analyzed.The patients were divided into infected group and non-infected group according to whether catheter-related bloodstream infection occurred.The puncture site samples and catheter tip samples of infected patients were collected for etiological detection and drug sensitivity test.The difference of baseline data between the two groups was analyzed,and the relationship between central venous catheter-associated infection and influencing factors was analyzed by multivariate logistic regression.Results A total of 249 patients were included in this study,including 54 patients in the infected group and 195 patients in the non-infected group.There were significant differences in age,catheterization position,ultrasound-guided puncture,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,catheter retention time and application of broad-spectrum antibiotics between the infected group and the non-infected group(all P<0.05).Multivariate logistic regression analysis showed that advanced age,femoral vein catheterization,no ultrasound-guided puncture,high APACHEⅡscore,long catheter indent time and application of broad-spectrum antibiotics were risk factors for central venous catheter-associated bloodstream infection.Among the 54 infected patients,Staphylococcus epidermidis accounted for 44.4%,followed by Escherichia coli accounted for 24.1%and fungus accounted for 11.1%.The resistance rate of gram-positive cocci to vancomycin was the lowest(3.4%)followed by tetracycline(34.5%),and the highest resistance rate was amoxicillin(100.0%).The resistance rates of gram-negative bacilli to amikacin and ceftriaxone were relatively high,both of which were 94.7%.Conclusions The risk factors for central venous catheter-related blood stream infection in patients with emergency hemorrhagic shock included advanced age,femoral vein catheterization,no ultrasound-guided puncture,high APACHEⅡscore,long catheter retention time and use of broad-spectrum antibiotics.The common pathogenic bacteria were Staphylococcus epidermidis and Escherichia coli.
作者
朱建平
许严新
吴绍宏
王飞瑶
张伟星
王瑞兰
Zhu Jianping;Xu Yanxin;Wu Shaohong;Wang Feiyao;Zhang Weixing;Wang Ruilan(Department of Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201620,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2024年第5期683-689,共7页
Chinese Journal of Emergency Medicine
关键词
失血性休克
中心静脉置管
导管相关性血流感染
病原学
耐药性
Hemorrhagic shock
Central venous catheterization
Catheter-related blood stream infection
Etiology
Drug resistance
